WHO analgesic ladder

Advanced, Pain

Step 1: Pain

i. Paracetamol

ii. ASA

iii. NSAID

b. Adjuvant

i. steroids

ii. anxiolytics

iii. antidepressants

iv. hypnotics

v. anticonvulsants

vi. antiepileptic-like gabapentinoids (gabapentin and pregabalin)

vii. membrane stabilizers

viii. sodium channel blockers

ix. NMDA receptor antagonists for the treatment of neuropathic pain

x. cannabinoids

Step 2: Pain persisting or increasing:

a. Opioid for mild to moderate pain

i. Codeine

ii. Tramadol

iii. Propoxyphene

iv. Buprenorphine

v. Oxycodone (low dose)

b. Non-opioid

c. Adjuvant

Step 3: Pain persisting or increasing:

a. Opioid for moderate to severe pain

i. Morphine

ii. Fentanyl

iii. Methadone

iv. Hydromorphone

v. Oxycodone

b. Non-opioid

c. Adjuvant

Step 4: Interventional Therapy:

a. Nerve block

b. Epidural

c. PCA therapy

d. Neurolytic block therapy

e. SCS/DCS

97%

Answered correctly

2019

Year asked

95%

Answered correctly

2015

Year asked

59%

Answered correctly

2014

Year asked

50%

Answered correctly

2010

Year asked